Search Results for: Le campagne di screening come strumento di prevenzione oncologica tra dubbi e certezze

Circulation, Volume 150, Issue Suppl_1, Page A4142200-A4142200, November 12, 2024. Introduction:Apolipoprotein B (ApoB) is a better marker of residual risk for cardiovascular disease in patients treated with lipid-lowering therapy (LLT) than low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C). However, it is unclear if treating to an apoB target is more cost-effective than treating to an LDL-C or non-HDL-C target.Methods:We used the CVD Policy Model, a validated computer simulation model, to estimate the clinical and economic outcomes associated with atherogenic lipid targets for LLT in a cohort of statin-eligible and ASCVD-free U.S. adults. We considered non-HDL-C, and apoB targets for intensification of LLT. Treatments considered were intermediate-intensity statin therapy, high-intensity statin therapy, and ezetimibe, intensified in that order. Upon entering the model, all individuals commenced statin therapy. Under ‘usual care,’ patients with LDL-C ≥100 mg/dL after three months of treatment were escalated to higher-intensity treatment. Under non-HDL-C and apoB testing strategies, LLT was escalated if patients had non-HDL-C ≥119 mg/dL and apoB ≥78.7 mg/dL, respectively, based on percentile equivalence to the LDL-C target. The primary outcomes for our study were healthcare costs (2023 U.S. dollars) and quality-adjusted life years (QALYs). Secondary outcomes were CVD events prevented and life years gained. A lifetime horizon was adopted with a health sector perspective. Future costs and QALYs were discounted at 3% annually.Results:In a sex-balanced simulated cohort of 500,000 individuals, both non-HDL-C and apoB testing produced more QALYs and fewer costs than usual care (LDL-C target). Intensification based on apoB, produced 1,416 more QALYs than non-HDL-C-guided intensification, saving around $29,300,000 over the lifecourse of the simulated cohort. Compared to non-HDL-C testing, apoB testing would lead to 1,233 fewer CVD events and 3,800 more life years. Health gains were greater for men, though apoB screening was cost-saving (i.e., higher QALYs, lower cost) when compared to LDL-C and non-HDL-C testing for men and women.Conclusion:Making LLT intensification decisions based on apoB instead of LDL-C or non-HDL-C would save costs while improving population health.

Circulation, Volume 150, Issue Suppl_1, Page A4144161-A4144161, November 12, 2024. Background:Percutaneous coronary intervention (PCI) is a cornerstone in the management of acute coronary syndrome (ACS) patients. Despite technological advancements, the occurrence of no-reflow phenomenon remains a significant concern among ACS patients. Atrial fibrillation (AF) is a common arrhythmia associated with cardiovascular events. We conducted a meta-analysis to investigate the potential influence of AF on the development of no-reflow in ACS patients following PCI.Methods:Relative risk (RR) with a 95% confidence interval (95%CI) served as the summary measure in our meta-analysis using the random-effects model to estimate the summary effect. The primary outcome is to investigate the potential influence of AF on the development of no-reflow in ACS patients following PCI. We assigned I2 > 50% as an indicator of statistical heterogeneity. P value

Circulation, Volume 150, Issue Suppl_1, Page A4146689-A4146689, November 12, 2024. Introduction:Mavacamten is a cardiac myosin inhibitor approved by the US FDA for the treatment of adults with symptomatic New York Heart Association class II-III obstructive hypertrophic cardiomyopathy to improve functional capacity and symptoms. Under the risk evaluation and mitigation strategy (REMS) program, patients taking mavacamten are required to be monitored for development of systolic heart failure (HF), with interruption if left ventricular ejection fraction (LVEF) decreases to

Circulation, Volume 150, Issue Suppl_1, Page ASa1003-ASa1003, November 12, 2024. Introduction:Many post-cardiac arrest (CA) therapies shown to be effective in animal models have failed to translate in human clinical trials. The predominance of single site pre-clinical studies, which lacks the heterogeneity and variability inherent in multicenter human clinical trials, could contribute to this failure. Multicenter pre-clinical studies might yield variability that more closely approximates human clinical trials, and thus result in reduction of bias and better initial screening of interventions. Here we describe the variability of CA characteristics among participating centers of an international multicenter preclinical CA research network.Methods:This is a retrospective analysis of control group subject data from swine CA studies submitted to the TRANSatlantic Cardiac arrEst Neuroprotection aDvancement (TRANSCEND) Network pre-clinical registry. Data for 101 animals from ten different models at seven institutions across the U.S.A, Europe, and Asia were included in this analysis. Data related to CA characteristics (intervals), post-CA characteristics (hemodynamics and blood gas at 1 hour post-ROSC), and neurological outcome were compiled and compared between the ten models. One-way ANOVA and Bartlett Test were used to estimate differences in means and standard deviations (SD). Chi Square test was used to compare proportions.Results:There were significant differences in CA characteristics between all ten models. The mean (SD) interval from CA to start of cardiopulmonary resuscitation was 8 (4)min (range of 2 to 14min) and from onset of CA to ROSC was 19 (7)min (range 13 to 38min) (p

Circulation, Volume 150, Issue Suppl_1, Page A4141975-A4141975, November 12, 2024. Background:Refugee populations often experience high rates of cardiovascular disease (CVD). Factors such as significant physiological stress, trauma, limited access to healthcare, substance abuse, and poor lifestyle choices contribute to disease progression and an increased incidence of cardiovascular events. We sought to evaluate the feasibility of using wearables to obtain high-fidelity ECG signals for CVD screening in refugees in Jordan.Methods:This observational cross-sectional study involved outpatients at one of four regional United Nations’ primary care clinics for Palestinian refugee in Jordan. Research assistants collected health histories from consented patients and recorded a 30-second, 6-lead ECG using a handheld, Bluetooth-enabled, wearable device (KardiaMobile 6L, AliveCor Inc., Mountain View, CA, USA). The digital ECG signals were stored on the Bluetooth-synced mobile device and then exported to a cloud server for offline analysis. The raw ECG recordings were preprocessed, and a single median beat was calculated per lead. Waveforms were segmented, and duration and amplitude measures were determined using a previously validated custom algorithm (University of Pittsburgh, PA, USA). All ECG recordings were reviewed by an independent physician.Result:The sample included 31 patients (age 52±13, 64% Females). Risk factors were prevalent in this group, including hypertension (74%), high cholesterol (65%), diabetes (64%), in-camp living (33%), and smoking (30%). Figure 1 shows the population-averaged median beat with 99% CI distribution of this sample. Mean QRS duration was 95±23 ms (range 53−150) and QTc interval was 403±53 (range 267−513). Most patients were in normal sinus rhythm (84%), and remaining patients were in atrial fibrillation or flutter (16%). Other clinically significant abnormalities included non-specific ST-T changes (9.7%), left bundle branch block (1.6%), and LVH with left ventricular strain (1.6%).Conclusion:This pilot study demonstrated that it is feasible to obtain high fidelity ECG signals using wearables to screen for CVD in refugees. Such affordable, noninvasive, point-of-care screening tools could enable early diagnosis and treatment in these patients.

Circulation, Volume 150, Issue Suppl_1, Page A4141269-A4141269, November 12, 2024. Background:Peripheral Artery Disease (PAD) is one of the most prevalent forms of cardiovascular disease, with many progressing to CV morbidity/death. Adherence to guideline-directed optimal medical therapy (OMT) in PAD is vital. This study evaluated adherence to prescribing OMT in patients with PAD.Methods:A retrospective study of 3,471 patients with PAD between 2017 and 2022 undergoing vascular laboratory imaging was performed. OMT was defined by 2016 AHA guidelines. Adherence to guidelines was denoted by active prescriptions for antiplatelet and statin therapy. Presence of high-intensity OMT (HIOMT) was defined as prescriptions for an antiplatelet and high-intensity statin. Prevalence and incidence (change to OMT /HIOMT within 60 days of index vascular laboratory visit) of OMT were evaluated. Multivariable models were created evaluating predictors of OMT and HIOMT prevalence and incidence.Results:OMT prevalence was 45.3% while HIOMT prevalence was 23.6% at the time of index vascular laboratory. Incident OMT was 24.3% while incident HIOMT was 11.2% within 60 days. Age, min/max ABI, insurance status, smoking status, and comorbidities were associated with prevalent OMT/HIOMT (table 1). Age, gender, min/max ABI, smoking status, and HgbA1c were associated with incident HIOMT (table 2). In multivariable models, incident HIOMT was less likely in women (OR 0.7; 0.52-0.91) whereas lower ABIs were predictive of HIOMT (OR 0.6; 0.51-0.72).Conclusions:Despite clear guidelines regarding OMT in patients with atherosclerotic cardiovascular disease, in this real-world study of guideline directed prescription management of PAD, adherence to OMT remains low, especially for HIOMT. Predictors of incident HIOMT include lower ABI while females were less likely to be on HIOMT. Given the high prevalence of PAD, heterogeneity of caregivers, widespread availability of screening, this population should be targeted for better adherence to HIOMT to prevent CV morbidity and death.

Circulation, Volume 150, Issue Suppl_1, Page A4135476-A4135476, November 12, 2024. Purpose:When the heart is exposed to stresses such as myocardial infarction or hypertension, it undergoes compensatory hypertrophy in response. However, continuation of the stress causes this compensatory mechanism to fail, and eventually systolic dysfunction or decompensated heart failure occur. As the hypertrophy of individual cardiomyocytes has been observed in this process, controlling cardiomyocyte hypertrophy is a potential target the prevention and treatment of heart failure. In this study, we constructed a high throughput screening (HTS) assay using cardiomyocyte hypertrophy as an index parameter. Compounds that inhibit cardiomyocyte hypertrophy were selected from our low molecular compound library.Methods and Results:In the primary screening, cultured rat primary cardiomyocytes were treated with each compound at a final concentration of 1 µM and then stimulated with 30 µM phenylephrine (PE) for 48 hours. These cells were subjected to fluorescent immunostaining with α-actinin, and cardiomyocyte area was measured using an ArrayScan™ system. The hypertrophy inhibition rate (%) of each compound was calculated as [(PE(+) – compound) / (PE(+) – PE(-))] × 100. The compounds with a hypertrophy inhibition rate greater than 50% and less than 150% were selected as hit compounds. In the secondary screening, these hit compounds were evaluated based on the dose-dependency of cardiomyocyte hypertrophy inhibition and the inhibition of the mRNA levels of the cardiac hypertrophy response genes ANF and BNP using real-time PCR. From the 269 low molecular-weight compounds in the original compound library, eight were selected through the primary and secondary screenings. Among them, we focused on Reference Number 409 (RFN-409). Western blotting indicated that RFN-409 inhibited PE-induced p38 activation. Next, we investigated the effect of RFN-409 on heart failure. Eight-week-old male C57 BL/6J mice were subjected to transverse aortic constriction (TAC) surgery and then randomly assigned to intraperitoneal treatment with RFN-409 (3, 10 mg/kg) or vehicle for eight weeks. RFN-409 at 10 mg/kg significantly prevented TAC-induced increase in left ventricular posterior wall thickness and decrease in left ventricular fractional shortening.Discussion:RFN-409 suppressed TAC-induced development of heart failure, at least partially by inhibiting p38 activity. These findings suggest that RFN-409 may be an effective agent for heart failure therapy.

Circulation, Volume 150, Issue Suppl_1, Page A4139569-A4139569, November 12, 2024. Background:Most connective tissue disorders (CTD) that cause aortic dilation (AoD) are hereditary. Children suspected of CTD may be referred to a pediatric cardiology or genetics clinic (PC) where the focus of care is on the child. While recommendations for screening of adult family members may be made, it is not typically performed on-site leading to potential gaps in care. We sought to evaluate the impact of a family-focused cardiovascular genetics (CVG) clinic on outcomes and to compare the impact of such a clinic to PC in preventing premature adverse aortic events (AE) in patients and family members.Methods:A retrospective records review of all pediatric (age < 21 years) encounters for CTD performed during the current era of genetic testing was conducted. Patients were included if AoD was identified. Location of initial clinic visit (PC vs. CVG) was noted. Children referred for a family history of known AoD were excluded. Recommendation for-, completion of-&results of- family screening were noted. Preventable adverse events, defined as AoD-related death/dissection in an undiagnosed proband or family member occurring after initial clinic encounter were recorded. Screening practices&outcomes were compared between clinic types.Results:Of 154 children who met inclusion criteria with a mean age of 11.1 (+/- 9.3) years, initial evaluation was performed in PC in 94 (61%)&CVG in 60 (39%) patients. Screening was recommended in 37 (39%) vs. 60 (100%) families seen in PC vs. CVG clinic (p

Circulation, Volume 150, Issue Suppl_1, Page A4147981-A4147981, November 12, 2024. Background:Lipoprotein(a) (Lp(a)) is now recognised as a key cardiovascular risk factor. Genetically determined and stable throughout adulthood, Lp(a) increases thrombotic risk and promotes atherosclerosis. Doubling Lp(a) levels raises cardiovascular disease risk by 22%. We aimed to evaluate the potential of Lp(a) to predict subclinical coronary artery disease in a well-characterised CCTA cohort, where early plaque detection may guide personalised treatment.Method and Results:1,718 participants from the BioHEART-CT cohort were included in this analysis, who presented for a CCTA for suspected CAD without a prior history of myocardial injury or revascularisation between 2015 and 2021. CAD burden was assessed using coronary artery calcium scores and Gensini scores. Lp(a) levels were measured using ELISA.We evaluated the ability of Lp(a) to reclassify patients into correct CAD risk prediction categories: 30% high risk. Logistic regression, adjusting for age, sex, hypertension, diabetes, hypercholesterolemia, and smoking status, revealed a net reclassification index (NRI) of 16% (p=0.001) and an integrated discrimination improvement (IDI) of 0.0046 (p=0.03), indicating accurate reclassification of one in 20 patients. In clinically actionable CAD (calcium score ≥100) cases, 26% were correctly reclassified from low to intermediate risk, 21% from intermediate to high risk, and only 2% were incorrectly reclassified. For non-clinically actionable CAD, 10% shifted from high to intermediate risk, 5% from intermediate to low risk, while 14% and 6% were misclassified into higher and intermediate-risk groups, respectively.Conclusion:Consideration of Lp(a) can potentially triage patients otherwise considered low risk for imaging to identify and treat atherosclerosis. It serves as an important screening biomarker with the potential to serve as an important non-invasive tool to identify vulnerable CAD patients who are currently underdiagnosed, such as patients without standard modifiable cardiovascular risk factors (SMuRFs).

Circulation, Volume 150, Issue Suppl_1, Page A4136799-A4136799, November 12, 2024. Introduction:The prevalence of heterozygous familial hypercholesterolemia (HeFH) is 1:250. Untreated individuals have up to a 20-fold increased risk for premature coronary artery disease (CAD). In adults, low socioeconomic status (SES) individuals, bear a disproportionate share of the CAD burden. In this context, we sought to examine the association of social determinants of health and age at HeFH diagnosis and treatment.Methods:We performed a retrospective single-center study of children with HeFH who presented to the Lipid Heart Clinic at the Children’s Hospital of Philadelphia (2012-2022). The primary outcome was age at HeFH diagnosis. The secondary outcome was age at statin initiation. Multivariable linear regression models were used to examine the association between the primary exposure of interest, Child Opportunity Index (COI) and the outcomes. Secondary exposures included race, ethnicity, health insurance, and primary language. To explore potential referral bias, we compared the COI of the study cohort to that of the institution’s catchment area, defined as within a two-hour drive of the primary clinic.Results:We evaluated 577 patients. The median age at presentation was 12 (9, 14) years and the median LDL-C was 199 (169, 235) mg/dL; 58% were prescribed a statin with a median age of statin initiation of 13 (10, 15) years. The median COI for the cohort was 84 (62, 95). There was no association between COI, ethnicity, health insurance, or primary language and the age at HeFH diagnosis or statin initiation. On multivariable analysis, black race was associated with older age at HeFH diagnosis compared to white race (adjusted estimate 1.2 +/- 0.49 yrs, p = 0.014). There was no difference in age at statin initiation by race. Higher LDL-C, male sex, and lower BMI percentile were associated with younger age at statin initiation. The COI distribution of the study cohort was significantly different than that of the catchment area (p < 0.001). 70% of the study cohort were of high and very high COI compared to 57% of the catchment area.Conclusion:Black race was associated with older age at HeFH diagnosis, however, there were no disparities in age at statin initiation. The COI of the cohort was significantly higher than that of the catchment area suggesting that low COI populations are under-referred for HeFH evaluation. Future efforts should focus on improving barriers to universal screening and identifying obstacles to HeFH diagnosis and referrals.

Circulation, Volume 150, Issue Suppl_1, Page A4113188-A4113188, November 12, 2024. Introduction:Physical activity (PA) may be associated with a lower risk of atrial fibrillation (AF), but this relationship remains controversial. In particular, further research is needed on the association between changes in PA intensity and AF risk among older adults.Hypothesis:We hypothesized that an increase in PA intensity would be associated with a reduced risk of AF among older adults aged 65 years and older in South Korea.Aim:This cohort study aimed to evaluate the association between changes in metabolic equivalent tasks (METs)-min/week and the risk of AF in the elderly using a nationally representative database.Methods:We conducted a retrospective cohort study using the Korea National Health Insurance Service (KNHIS) database. This cohort included 1,726,697 individuals aged 65 years and older without a history of cardiovascular disease diagnosis who underwent two consecutive health screening examinations from 2009 to 2012. PA was defined as MET-min/week derived from two consecutive health examinations during 2009-2010 (1st period) and 2011-2012 (2nd period), respectively. The primary outcome was an AF diagnosis during the follow-up period from 2013 to 2021. We estimated the sub-distribution hazard ratio (sHR) and 95% confidence interval (CI) for the association of changes in PA intensity with AF using Fine-Gray sub-distribution hazard models after adjustment for covariates.Results:This study included 1,726,697 participants (mean age 71.08; 46.78% male). An increase in PA intensity was associated with a reduced risk of AF (P for trend

Circulation, Volume 150, Issue Suppl_1, Page A4138519-A4138519, November 12, 2024. Introduction:Cardiovascular disease (CVD) and cancer are leading causes of morbidity and mortality. Since they share risk factors, it is plausible that CVD risk scores and cardiovascular health (CVH) metrics could also be used to predict cancer.Research Question:What is the relationship between established CVD risk scores and CVH metrics and the incidence of cancer?Methods:A librarian searched four databases (Embase, PubMed, Scopus, Web of Science: Core) in February 2024 without language restriction. Using Covidence, two reviewers independently screened the titles, abstracts, and full texts of the retrieved articles based on the inclusion criteria (prospective observational studies, adults aged ≥18 years, reported incidence of any type of cancer as an outcome, and used at least one CVD risk score or CVH metric as an exposure). A third reviewer resolved conflicts. The characteristics of the studies retained after screening and the summary estimates of the associations were extracted using Excel.Results:Of the 4,165 records screened, 13 studies (reporting 14 CVD or CVH metrics) were included. The heterogeneity in the scales (comparison group) precluded a meta-analysis. Four studies evaluated CVD risk scores (Atherosclerotic Cardiovascular Disease [ASCVD], Framingham Risk Score, Systematic Coronary Risk Evaluation), and 10 reported CVH metrics (American Heart Association [AHA] Life’s Simple 7, AHA Life’s Essential 8). Sample size ranged from 1,880 to 342,226, with median follow-up from 8.1 to 29.6 years. Most of the studies included more women than men (61.5%) and mean age ranged from 44.8 to 72 years. The majority of studies included all cancer types (71.4%), including breast, lung, colorectal, and prostate cancer subtypes, and the total number of cancer events ranged from 387 to 11,643. Studies utilizing CVD risk scores consistently reported that individuals with a higher CVD risk, developed any type of cancer, with hazard ratios (HRs) ranging from 1.02 to 3.71, and studies employing CVH metrics generally indicated an ideal CVH is associated with a lower cancer risk, with HRs ranging from 0.49 to 0.95.Conclusion:Despite heterogeneity in CVD risk metrics and cancer subtypes, most studies reported that higher CVD risk scores or worse CVH metrics may increase future cancer risk. More rigorous studies are needed focusing on specific CVD risk metrics and cancer types of cancer to produce evidence suitable for a meta-analysis.

Circulation, Volume 150, Issue Suppl_1, Page A4114198-A4114198, November 12, 2024. Background:Mitochondrial dysfunction contributes to heart failure (HF) progression via diminished energy supply, release of reactive oxygen species, and increased cell death. However, there has yet to be clinically relevant biomarkers that address mitochondrial-mediated cardiac injury in patients. Humanin (HN) is a mitochondria-derived peptide that protects cells through the interference of apoptosis and reduction of oxidative stress. The objectives of our study were to measure circulating plasma HN levels in patients with HF with reduced ejection fraction and describe the relationship of HN to validated, clinically relevant measures of HF.Methods:We conducted a prospective cohort study. To be included in the study, patients must have: 1) left ventricular ejection fraction

Circulation, Volume 150, Issue Suppl_1, Page A4142220-A4142220, November 12, 2024. Background:There are limited data regarding left ventricular ejection fraction (LVEF) recovery rates among patients with anthracycline-induced cardiomyopathy (AIC).Aims:To assess the rate of LVEF recovery and its predictors in a contemporary and heterogenous cohort of patients with AIC.Methods:A retrospective cohort study of adult patients with new onset cardiomyopathy determined to be secondary to anthracyclines after a comprehensive work-up for potential etiologies within Massachusetts General Brigham between 2010 and 2023. LVEF recovery was defined as an absolute LVEF increase of ≥10% from LVEF at detection of AIC to a final LVEF ≥50%. Time to LVEF recovery within the first 3 years post-diagnosis was assessed using Cox proportional hazards regression analysis with all-cause death/mechanical circulatory support/heart transplant as competing risks based on the Fine-Gray method. Non-fatal cardiovascular (CV) events included acute decompensated heart failure, acute coronary syndrome and malignant arrhythmias requiring admission.Results:The cohort included 167 patients with AIC. The median age at anthracycline exposure was 60 (Q1, Q3: 48, 69) years, 53% (n=88) were females and majority had lymphoma (n=92, 55%) and breast cancer (n=39, 23%). The median time from first anthracycline exposure to detection of AIC was 631 (Q1, Q3: 219, 3569) days and median LVEF was 38 (Q1, Q3: 29, 45) %. A total of 42% (n=70) were managed by dedicated cardio-oncologists and neurohormonal therapy was prescribed in 86% (n=144). LVEF recovered in 38% (n=63) at a median time of 349 (Q1:Q3: 137, 691) days from AIC detection. Statin use was associated with a higher likelihood of recovery (HR=2.162, 95%CI:1.207-3.875, p=0.009), while age >60 at time of anthracycline exposure, non-white race, longer duration between anthracycline exposure and detection of AIC, increased LV end-diastolic diameter, and lymphoma vs. other cancers had lower adjusted odds of LVEF recovery. Patients with recovered LVEF were less likely to experience CV events during follow-up (HR=0.455; CI 0.22-0.95, p=0.036). LVEF recovery, as a time-dependent variable, was not associated with all-cause or cardiovascular death.Conclusion:In a contemporary cohort of patients with AIC, 38% experienced LVEF recovery and lack of recovery was associated with a higher burden of CV events requiring admission. Routine screening for AIC may improve the likelihood of recovery and improve outcomes.

Circulation, Volume 150, Issue Suppl_1, Page A4141994-A4141994, November 12, 2024. Background:Screening trials for atrial fibrillation (AF) have produced mixed results; however, it is unclear if there is a subset of individuals for whom screening would be effective. Identifying such a subgroup would support targeted screening.Methods:We conducted a secondary analysis of VITAL-AF (NCT03515057), a randomized trial of one-time, single-lead ECG screening during primary care visits. We tested two approaches to identify a subgroup that would benefit from screening (i.e., heterogenous screening effects). First, we use a potential outcomes framework to develop an effect-based model. Specifically, we predicted the likelihood of AF diagnosis under both screening and usual care conditions using LASSO, a penalized regression method. The difference between these probabilities was the predicted screening effect. Second, we used the CHARGE-AF score, a validated AF risk model. We used interaction testing to determine if the observed diagnosis rates in the screening and control arms were statistically different when stratified by decile of the predicted screening effect and predicted AF risk.Results:Baseline characteristics were similar between the screening (n=15187) and usual care (n=15078) groups (mean age 74 years, 59% female). On average, screening did not significantly increase the AF diagnosis rate (2.55 vs. 2.30 per 100 person-years, rate difference 0.24, 95%CI -0.18 to 0.67). Patients in the highest decile of predicted screening efficacy (n=3026, 10%) experienced a large and statistically significant increase in AF diagnosis rates due to screening (6.5 vs. 3.06 per 100 person-years, rate difference 3.45, 95%CI 1.62 to 5.28; interaction p-value 0.038) (Figure 1). In this group, the mean age was 84 years and 68% were female. Participants in the highest decile of AF risk using the CHARGE-AF score did not have a statistically significant increase in AF diagnosis rates due to screening (Figure 2). Predicted screening effectiveness and predicted AF risk were poorly correlated (Spearman coefficient 0.13).Conclusions:One-time screening may increase AF diagnoses in a subgroup of older adults with the largest predicted screening effect. In contrast, predicted AF risk was a poor proxy for predicted screening efficacy. These data caution against the assumption that high AF risk is necessarily correlated with high screening efficacy. Prospective studies are needed to validate whether AF screening is effective in the subgroup identified in this study.

Circulation, Volume 150, Issue Suppl_1, Page A4144167-A4144167, November 12, 2024. Background:Myocardial ischemia remains a significant global health concern for cardiovascular morbidity and mortality. In addition to the traditional treatment modalities, stem cell transplantation is emerging as a promising therapeutic intervention for cardiac regeneration and functional recovery. Our study evaluated the efficacy and clinical impact of SCT by reducing infarct scar size and improving cardiac function. The secondary objectives are to compare stem cell types, identify optimal transplantation strategies, and address safety and feasibility.Method:Randomized controlled trials from January 2000 to July 2023 were collected from PubMed, Cochrane, Google Scholar, and Elsevier. Based on criteria and evidence quality, screening and selection were done. A RevMan analysis was done. Infarct size, LVEF, LVESV, LVEDV, and mortality were measured. Comparator variables included placebo, medical therapy, CABG, and other types of stem cells. Randomization, allocation concealment, blinding, and therapeutic interventions differed among trials. Heterogeneity and publication bias were assessed using random-effects model and funnel plots. Sensitivity analysis and meta-regression identified outcome variability.Results:Seventeen studies (n = 1022 patients) met the inclusion criteria, encompassing various cell types, doses, and administration routes. Compared to controls, SCT greatly enhanced LVEF (MD: 3.39, 95% CI: 1.05 to 5.73, p = 0.005) and reduced infarct size (MD: 14.23, 95% CI: 7.12 to 21.35, p